			Home About us Contact

LT Candidates (lt + candidate)

Distribution by Scientific Domains

Medical Sciences	75%

Selected Abstracts

Benefit of downsizing hepatocellular carcinoma in a liver transplant population

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2010
J. W. JANG
Aliment Pharmacol Ther,31, 415,423 Summary Background, Long-term results after downstaging hepatocellular carcinoma (HCC) prior to liver transplantation (LT) remain unknown. Aims, To investigate dropouts and post-transplant outcome among patients with downstaged HCC by transarterial chemo-lipiodolization (TACL). Methods, Between 2000 and 2007, 386 patients with HCC initially exceeding Milan criteria underwent TACL for tumour downstaging and were consecutively enrolled. Results, Overall, 160 (41.5%) patients achieved successful downstaging of HCC to within Milan criteria. During the follow-up, 82 eventually dropped off the waiting list for LT, with estimated dropout rates at 1, 2 and 5 years of 46.7%, 70.2%, and 87.2%, respectively. The overall post-transplant survival rates at 1, 2 and 5 years were 89.2%, 70.3% and 54.6% and the corresponding rates for recurrence-free survival were 74.7%, 71.8% and 66.3% respectively. Multivariate analysis indentified alpha-fetoprotein (AFP) levels ,100 ng/mL at LT (P = 0.003), maximum tumour size ,7 cm (P = 0.002) and the lack of complete necrosis by TACL (P = 0.048) as independent predictors of HCC recurrence after LT. Patients with none of these risk factors had an excellent post-transplant outcome, with an 87.5% probability of recurrence-free survival up to 6 years. Conclusions, These long-term results may contribute to the database for optimizing management of LT candidates with downstaged HCC. Based on our data, patients with a maximum tumour size <7 cm who achieve complete necrosis together with AFP levels <100 ng/mL at LT may be the best candidates for LT following downstaging using TACL. [source]

Toward a Socioliterate Approach to Second Language Teacher Education

MODERN LANGUAGE JOURNAL, Issue 3 2002
John S. Hedgcock
This article proposes that effective language teacher preparation should facilitate candidates' access to the shared knowledge, discursive practices, and instructional processes of language teaching (LT) as an inherently disparate discipline. Whereas the reflective orientation widely embraced in North American teacher education programs should be preserved, reflective practice should be promoted within a socioliterate framework. The author explores the position that teacher education must be grounded partly (though not exclusively) in what is commonly called "theory," but that this theoretical dimension should be developed by systematically examining socioeducational practices. A genre,based, sociorhetorical approach to LT discourse, it is argued, can build candidates' awareness of knowledge,construction practices, enhance their declarative knowledge, and develop their professional skills. By modeling analytic and reflective processes that focus on disciplinary knowledge, teacher education can help LT candidates to shape their own professional literacies, enabling them to participate meaningfully in the profession's many conversations. [source]

Clinical Burden of Screening Asymptomatic Patients for Coronary Artery Disease Prior to Liver Transplantation

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2009
D. Filì
The aim of this study is to assess the clinical burden of silent coronary artery disease (CAD) in cirrhotic candidates for liver transplantation (LT), and to evaluate the usefulness of a CAD screening approach. Between July 1999 and January 2006, we evaluated 627 LT candidates. All of them underwent a detailed clinical history. Sixteen had a previous diagnosis of CAD or symptoms suggestive (2.5%). The remaining 611 underwent further tests according to a predefined protocol, including EKG, echocardiogram and, on the basis of CAD risk factors, heart stress tests. Selective coronary angiography (SCA) was performed in the 30 patients with positive heart stress test: in only 2 did SCA show any CAD, and in both it was subcritical disease requiring neither intervention nor contraindicating LT. The 611 screened patients continued their follow-up until study closure or death. No coronary events occurred in the study population in a mean follow-up of 32.50 months (+/, 23.67 DS). No perioperative mortality related to CAD occurred in the 233 transplanted patients. In conclusion, no prognostic advantage was achieved by following a strict CAD screening protocol, leading us to believe that the cost-effectiveness of a similar screening can be unacceptably high in our setting. [source]

Our experience in liver transplantation in patients over 65 yr of age

CLINICAL TRANSPLANTATION, Issue 1 2008
Itxarone Bilbao
Abstract: Objectives:, The aim of this study was to analyze short- and long-term results of liver transplantation (LT) in patients over 65 yr. Material and methods:, Between 1996 and 2004, 386 patients underwent 415 LT at our center. The main indication for LT was post-necrotic cirrhosis in 59%, followed by hepatocellular carcinoma (HCC) over cirrhosis in 33%. Half of the patients (53%) were hepatitis C virus (HCV) +. Overall, 72 patients were >65 yr of age. Actuarial survival, causes of mortality and postoperative complications were compared between groups: patients under and over 65 yr. Risk factors for poor outcome in patients over 65 yr were also analyzed. Results:, The older group had more patients at Child A stage, more HCC as an indication for LT and more HCV (+) patients, p < 0.05. No differences were observed in donor and surgery characteristics, except for lower multi-transfusion and higher incidence of grafts with steatosis in the older group (p < 0.05). Actuarial survival at one, three, five and 10 yr was 82%, 75%, 72%, and 70% for the <65 yr group vs. 77%, 66%, 55%, and 55% for the >65 yr group (p = 0.03). Main causes of mortality in patients >65 yr were recurrence of underlying disease and medical causes. In the older age group, fewer infections (p = ns) and rejections (p = 0.017) occurred in the postoperative period. Risk factor for poor outcome in the group of patients over 65 yr in multivariate analyses was pre-LT renal insufficiency (odds ratio 3.5, p = 0.002, 95% confidence interval 1.58,7.82). Conclusion:, Results in patients >65 yr are comparable to those <65 yr if older LT candidates are carefully selected. Overimmunosuppression should be avoided in older candidates, as its effects could worsen the pre-existing diseases common in elderly patients. [source]